Dr. Madhav Tiwari
General Surgery
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I visited the doctor a year ago and was diagnosed with a UTI. Following a referral to a urologist, I underwent an ultrasound and PSA test, leading to a diagnosis of benign prostatic hyperplasia. I was prescribed Finasteride, and I shared the ultrasound results in our recent consultation about a month ago. My PSA test, taken five months before starting Finasteride, showed a value of 2.5. A month ago, I was diagnosed with NGU urethritis, experiencing symptoms like itching during urination and clear discharge. I was prescribed a seven-day course of Doxycycline and two tablets of Cefixime. While all symptoms initially disappeared about four days after starting the medication, the slight clear discharge returned five days ago, primarily occurring during the day with minimal volume.
Kindly provide your suggestion.
Hello,
Welcome to icliniq.com.
I read your query and understood your concern.
Regarding the discharge, it may be due to incompletely treated urethritis, possibly caused by a bacterium like Mycoplasma genitalium, which tends to respond better to a different medication, Azithromycin (antibiotic). Do you have any information or reports indicating the isolated organism when urethritis was initially diagnosed? However, it is puzzling why you developed urethritis, especially considering your monogamous relationship. There might be a connection to a certain degree of prostatitis, a common occurrence in individuals with benign prostatic hyperplasia (BPH). Additionally, I previously suggested you a uroflowmetry test for your enlarged prostate. Opting for simpler drugs like alpha blockers, as opposed to Finasteride, could potentially be more suitable for managing your BPH.
I hope this has helped you.
Kindly follow up if you have more doubts.
Thank you.
Patient's Query
Hello doctor,
I consulted my doctor again, and he prescribed another round of Doxycycline. I completed that and all symptoms are gone, except a very slight burning sensation occasionally. I would not even call it a burn, but just a slight feeling. I still have a feeling of fullness or slight pressure in the groin, like something similar to an urge to pass urine. I pass urine about every four hours on n average, and at night, I get up maybe twice because I usually have one beer. But I went and did a PSA test on my own, and it came back at 2.6. I have been on Finasteride for a few months. I am really worried. PSA was 2.5 before I started Finasteride. The regular urine test was negative, so with my symptoms, my doctor diagnosed me with urethritis and prescribed Doxycycline twice.
Please advise.
Thank you.
Hi,
Glad to have you back!
I am here to help you get the best medical advice.
Finasteride takes at least six months to half the PSA (prostate-specific antigen) test. So you have still not crossed the threshold. A PSA of 2.6 ng/ml. at this stage, there is nothing to worry about. I may sound repetitive, but you really do need to be worked up for prostatitis (inflammation of the prostate) and perhaps, an alpha blocker would be more suited to you compared to finasteride.
I hope this information helps provide some insight into your symptoms.
Please do not hesitate to reach out if you have any further questions or concerns.
Thank you.
Patient's Query
Hello doctor,
I will be traveling home for a visit. I am still having some issues. There is an occasional mild discharge that is clear and an occasional very slight burning sensation. Sometimes I have a burning sensation at the beginning of urination, but not always. Sometimes, when sitting on a couch, I feel like I will almost pass urine, but I do not actually. That usually happens while sitting late in the evenings. Could you please prescribe me an antibiotic? My doctor has prescribed Doxycycline twice and it gets rid of symptoms. However, it comes right back after about two weeks. I think I need something stronger and for a longer duration. I just want to be able to travel home for the holidays without having these issues.
Please help.
Hello,
Glad to have you back!
I am here to help you get the best medical advice.
Here is my recommendation:
1. Capsule Flomax (Tamsulosin) 0.4 mg once daily at night.
2. Tablet Econorm (Saccharomyces boulardii) 250 mg twice daily.
3. Tablet Cranberry D Mannose (Cranberry and D-Mannose extracts) twice daily. Consult your doctor and take the medication accordingly. Continue this medication for three months. Continue capsule Doxycycline 100 mg twice daily for one month.
I hope this information helps provide some insight into your symptoms.
Please do not hesitate to reach out if you have any further questions or concerns.
Thank you.
Patient's Query
Hi doctor,
Can you provide a prescription for me?
Thank you.
Hi,
Glad to have you back!
I am here to help you get the best medical advice.
Based on the MRI (magnetic resonance imaging) findings (attachments removed to protect patient identity), I do not see any cause for concern. There are no features described on the MRI that point towards prostate cancer. PSA can be elevated in non-cancer enlargement of the prostate (BPH) as well, and that is what has most likely happened in your case. So I would recommend you not get stressed about the PSA density. Please consider my previous suggestion of using an alpha block, Dutasteride as opposed to Finasteride alone - it will greatly benefit you in my opinion.
I hope this information helps provide some insight into your symptoms.
Please do not hesitate to reach out if you have any further questions or concerns.
Thank you.
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General Surgery
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